Provider Demographics
NPI:1356811251
Name:KENDALL, ELIZABETH ANGUSTA (LMT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANGUSTA
Last Name:KENDALL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2833 CHENA HOT SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99712-3214
Mailing Address - Country:US
Mailing Address - Phone:406-916-9701
Mailing Address - Fax:
Practice Address - Street 1:382 OLD CHENA PUMP RD
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-2936
Practice Address - Country:US
Practice Address - Phone:907-313-8971
Practice Address - Fax:907-313-1418
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-04
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101741225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist